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Cost-effectiveness and budget impact of immediate antiretroviral therapy initiation for treatment of HIV infection in Cote d'Ivoire: A model-based analysis

dc.rights.licenseopenen_US
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorOUATTARA, Eric
dc.contributor.authorMACLEAN, R. L.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorDANEL, Christine
dc.contributor.authorBORRE, E. D.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorGABILLARD, Delphine
dc.contributor.authorHUANG, M.
dc.contributor.authorMOH, Desmorys Raoul
dc.contributor.authorPALTIEL, A. D.
dc.contributor.authorEHOLIE, S. P.
dc.contributor.authorWALENSKY, R. P.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorANGLARET, Xavier
dc.contributor.authorFREEDBERG, K. A.
dc.date.accessioned2020-07-09T08:55:00Z
dc.date.available2020-07-09T08:55:00Z
dc.date.issued2019
dc.identifier.issn1932-6203en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/10259
dc.description.abstractEnINTRODUCTION: The Temprano and START trials provided evidence to support early ART initiation recommendations. We projected long-term clinical and economic outcomes of immediate ART initiation in Cote d'Ivoire. METHODS: We used a mathematical model to compare three potential ART initiation criteria: 1) CD4 <350/muL (ART<350/muL); 2) CD4 <500/muL (ART<500/muL); and 3) ART at presentation (Immediate ART). Outcomes from the model included life expectancy, 10-year medical resource use, incremental cost-effectiveness ratios (ICERs) in $/year of life saved (YLS), and 5-year budget impact. We simulated people with HIV (PWH) in care (mean CD4: 259/muL, SD 198/muL) and transmitted cases. Key input parameters to the analysis included first-line ART efficacy (80% suppression at 6 months) and ART cost ($90/person-year). We assessed cost-effectiveness relative to Cote d'Ivoire's 2017 per capita annual gross domestic product ($1,600). RESULTS: Immediate ART increased life expectancy by 0.34 years compared to ART<350/muL and 0.17 years compared to ART<500/muL. Immediate ART resulted in 4,500 fewer 10-year transmissions per 170,000 PWH compared to ART<350/muL. In cost-effectiveness analysis, Immediate ART had a 10-year ICER of $680/YLS compared to ART<350/muL, ranging from cost-saving to an ICER of $1,440/YLS as transmission rates varied. ART<500/muL was "dominated" (an inefficient use of resources), compared with Immediate ART. Immediate ART increased the 5-year HIV care budget from $801.9M to $812.6M compared to ART<350/muL. CONCLUSIONS: In Cote d'Ivoire, immediate compared to later ART initiation will increase life expectancy, decrease HIV transmission, and be cost-effective over the long-term, with modest budget impact. Immediate ART initiation is an appropriate, high-value standard of care in Cote d'Ivoire and similar settings.
dc.language.isoENen_US
dc.rightsAttribution 3.0 United States
dc.rights.urihttps://creativecommons.org/licenses/by/3.0/us/
dc.subject.enIDLIC
dc.title.enCost-effectiveness and budget impact of immediate antiretroviral therapy initiation for treatment of HIV infection in Cote d'Ivoire: A model-based analysis
dc.title.alternativePLoS Oneen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1371/journal.pone.0219068en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed31247009en_US
bordeaux.journalPLoS ONEen_US
bordeaux.pagee0219068en_US
bordeaux.volume14en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue6en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-02894743
hal.version1
hal.date.transferred2020-07-09T08:55:06Z
hal.exporttrue
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